Nasir Ali Quraishi

Study Design: Retrospective concordance analysis. Objective: To evaluate the concordance between ChatGPT-4 and a spinal multidisciplinary team (MDT) in management decisions for metastatic spinal disease and to explore the potential role of large language models (LLMs) as decision-support tools in oncologic spine care. Summary of Background Data: Management of metastatic spinal disease requires multidisciplinary input balancing neurological preservation, mechanical stability, and systemic prognosis. Frameworks such as the Spine Instability Neoplastic Score (SINS) and the NOMS model guide decisions, but variability persists. Artificial intelligence tools like ChatGPT may standardize reasoning, yet their concordance with expert MDTs remains unexplored in this context. Methods: A retrospective analysis was performed on 100 anonymized adult cases referred to a spinal MDT for spinal metastases with suspected instability or metastatic spinal cord compression (MSCC). Ten additional cases were used to calibrate the model input. Each case summary, including demographics, tumor histology, SINS, Karnofsky Performance Scale, and Tokuhashi estimates, was presented identically to ChatGPT-4 (OpenAI, March 2025 snapshot) and the MDT. Management recommendations: surgical versus palliative (noncurative therapy including radiotherapy, systemic treatment, or best supportive care) were compared using Cohen κ, and discordant cases underwent qualitative analysis. Results: ChatGPT and the MDT were concordant in 86% of cases (κ=0.66, P <0.001), indicating substantial agreement. Concordant recommendations included surgery in 26% and palliative care in 60%. Discordance occurred in 14% of cases, typically involving younger patients or rare tumor histologies. ChatGPT emphasized mechanical instability and high SINS scores, whereas the MDT weighted systemic prognosis more heavily. Conclusions: ChatGPT-4 achieved substantial concordance with expert MDT decision-making in metastatic spinal disease. While it aligned well in structurally clear-cut cases, discordance in prognostically complex scenarios underscores the need for prognosis-aware, dynamically validated AI models. These findings support AI as an adjunct—not a replacement—for multidisciplinary clinical workflows.

Purpose: Sexual dysfunction is a recognised but underreported outcome following cauda equina syndrome (CES), with existing evidence fragmented and methodologically heterogeneous. Its true prevalence and clinical significance remain unclear. To systematically evaluate the prevalence, characteristics, and predictors of long-term sexual dysfunction following CES. Methods: A systematic review was conducted in accordance with PRISMA guidelines. Studies reporting sexual function outcomes following CES were identified from database inception to 16 December 2025. Eligible studies included adult patients undergoing surgical decompression for CES with extractable long-term sexual function data. Data were synthesised narratively with exploratory quantitative pooling where appropriate. Results: Five studies were included. Sexual dysfunction was common, with reported prevalence ranging from 48% to 67% and a pooled estimate of 58.4% at long-term follow-up. Dysfunction affected both men and women and extended beyond erectile dysfunction to include impairments in arousal, orgasm, and satisfaction. Studies using validated patient-reported outcome measures generally reported broader and higher burdens of dysfunction than studies relying on descriptive or neurological assessment alone. Limited evidence suggested associations with increasing age, longer duration of pre-operative bladder dysfunction, and markers of sacral nerve root involvement, including bowel dysfunction and perianal sensory loss. Timing of surgery was not consistently associated with long-term sexual outcomes. Baseline sexual function was rarely reported. Conclusions: Sexual dysfunction affects more than half of patients following CES and represents a persistent and under-recognised component of long-term morbidity. Current evidence is limited by heterogeneity and lack of baseline assessment, but suggests that outcomes are driven more by severity of neural compromise than timing alone. Routine assessment using validated patient-reported measures should be incorporated into CES follow-up to better define recovery and guide patient counselling.

Background Cage subsidence is a common radiographic finding following transforaminal lumbar interbody fusion (TLIF), but its clinical relevance remains uncertain. Hounsfield Unit (HU) values from preoperative CT scans have emerged as surrogates for local bone quality, yet few studies have validated simple, clinically applicable prediction models or examined the relationship between subsidence and functional outcomes. Methods Retrospective analysis of 76 patients who underwent single-level TLIF (2019–2023) with preoperative CT imaging and 12-month follow-up. HU was measured at the fused vertebral bodies. Cage subsidence was defined as ≥ 2 mm vertical migration or disc height loss on CT at 6–12 months. Logistic regression, Random Forest, and XGBoost models were applied to identify key predictors. A three-point bedside score (HBA-3) was derived using ROC/Youden thresholds for HU (< 131), BMI (> 30), and age (≥ 60). Outcomes included Oswestry Disability Index (ODI), EQ-5D VAS, and patient satisfaction. Results The overall subsidence rate was 31.6% (24/76). HU, BMI, and age consistently emerged as the strongest predictors across all models, while sex, smoking, alcohol, and cage type contributed minimal signal. The HBA-3 score stratified subsidence risk stepwise from 12.5% (0 points) to 50.0% (3 points), with good discrimination (cross-validated AUC = 0.73; logistic 0.70, RF 0.73, XGBoost 0.72). Inter-rater reliability of HU was excellent (ICC = 0.98). Despite these radiographic findings, subsidence was not associated with worse PROMs at 12 months (satisfaction p = 0.29; ODI p = 0.66; EQ-5D VAS p = 0.87). Higher HBA-3 scores were not associated with ODI at 12 months (p = 0.45) or ODI MCID attainment (p = 0.25). ODI improved significantly at 12 months (− 12.0, p < 0.0001), while EQ-5D showed no significant change. Conclusion The HBA-3 score (HU, BMI, age) provides a simple, reproducible tool for estimating subsidence risk after TLIF, with stepwise increases in risk across strata. However, radiographic subsidence did not predict functional recovery in this single-level degenerative cohort, underscoring the need to distinguish between radiographic and patient-centred outcomes.

Objectives To determine how often adult spinal deformity (ASD) surgery meets preoperative sagittal alignment goals and whether these corrections are durable over time, including the impact of planning frameworks and enabling technologies. Methods We performed a PRISMA-guided search of MEDLINE, EMBASE, Web of Science, Cochrane Library, and Scopus through June 2025. Eligible studies enrolled adults undergoing ASD surgery where preoperative alignment targets were defined by numeric thresholds (e.g., SVA, PI–LL, PT), algorithmic frameworks (e.g., Roussouly, GAP), or technology-assisted modalities (e.g., virtual surgical planning/patient-specific rods/robotics/custom implants). Outcomes included plan-to-achieved alignment fidelity, longitudinal maintenance of targets, mechanical complications, and PROMs. Risk of bias was assessed with ROBINS-I. When data were sufficiently homogeneous, random-effects meta-analyses were performed for commonly reported targets (SVA < 5 cm, PI–LL ≤ 10°, PT ≤ 20°). Results Fifteen unique studies (Fig. 1) from 2006–2025 encompassing ~ 1,980 patients reported outcomes for achieving preoperative alignment goals in ASD. Cohort sizes ranged from 15 to 608; among cohorts reporting demographics, mean age was 65 years (range means 58–72) with 68% female (57–80%). Mean follow-up was 20 months (immediate postoperative to 5 years). Across studies, most patients achieved early postoperative targets for SVA, PI–LL and/or PT, though durability attenuated on longer follow-up in several cohorts. Algorithm-driven planning—particularly restoration to a Roussouly-consistent profile—was associated with lower mechanical complication rates, while technology-assisted approaches (virtual planning/patient-specific rods/custom implants/robotics) generally improved plan-to-achieved fidelity; translation to superior PROMs was inconsistent. Overall study quality varied: several small, single-center series were at higher risk of bias, whereas multicenter prospective cohorts showed lower risk but remained heterogeneous in definitions, targets, and follow-up windows. Prisma chart [17] Conclusions Adult spinal deformity surgery reliably achieves planned sagittal alignment early postoperatively, but long-term durability is variable. Pelvic tilt is the most difficult parameter to correct and maintain, with loss of correction by one to two years. Alignment strategies emphasizing restoration of physiologic sagittal profile, particularly Roussouly-based frameworks, show superior long-term maintenance and fewer mechanical failures than isolated numeric targets. Although patient-reported outcomes improve consistently, enabling technologies enhance alignment fidelity without consistent incremental PROM benefit. Future studies should prioritize profile-driven, patient-specific planning and assess durability and patient-centered outcomes beyond two years in prospective multicenter cohorts.

Background While the primary goal of treating Adolescent Idiopathic Scoliosis (AIS) is curve correction, long-term psychological and sexual outcomes are rarely examined. This systematic review evaluates whether bracing or surgical treatment affects sexual health, body image, and psychological well-being compared to healthy controls. Methods A systematic review was conducted in accordance with PRISMA guidelines. PubMed, Embase, and CENTRAL were searched up to November 2024 for studies assessing sexual and psychological outcomes in AIS patients treated with bracing or surgery. Inclusion criteria encompassed observational and interventional studies with validated outcome tools. Risk of bias was assessed using the ROBINS-I tool. Results Nine studies involving 3231 participants were included. Among 1085 AIS patients (average age at treatment 15.6 years; female-to-male ratio 18:1), 498 underwent bracing and 587 underwent surgery. Meta-analyses demonstrated that AIS patients had significantly lower sexual function (FSFI: SMD = 0.54, 95% CI: 0.29–0.80), higher sexual distress (FSDS: SMD = 0.76, 95% CI: 0.21–1.32), and reduced sexual satisfaction (GSSI: SMD = 0.39, 95% CI: 0.10–0.74) compared to controls, with low heterogeneity across outcomes (I² = 0%). Narrative synthesis further revealed higher rates of body image dissatisfaction and reduced self-esteem among AIS patients. Surgically treated individuals showed marginally better sexual satisfaction than braced patients, though differences in psychological and intimacy outcomes were inconsistent. Physical limitations and pain-related sexual dysfunction were noted across both treatment groups. Conclusion AIS treatment may influence long-term sexual and psychological health, particularly among brace-treated patients. While surgical intervention may offer modest benefits, evidence remains limited. These outcomes should be incorporated into AIS follow-up and future research, emphasizing patient-centred care.

Background/Objectives: Adult spinal deformity (ASD) is increasingly prevalent due to an ageing population and is associated with significant pain, disability, and reduced quality of life. While surgery is often considered for severe deformities, many patients are either unsuitable for major corrective procedures or prefer conservative care. This narrative review synthesizes the current evidence on nonoperative management strategies for ASD. Methods: A literature search on the PubMed and Cochrane databases identified relevant studies published up to 25 October 2025. Medical Subject Headings and keywords related to nonsurgical ASD management were used. Eligible studies included nonsurgical series with a minimum of 12 months’ follow-up, while case reports were excluded. Results: Seven studies met our inclusion criteria: three on bracing, three on physiotherapy and combined physical and cognitive rehabilitation programmes, and one on transforaminal epidural steroid injections (ESIs). Bracing was effective in slowing the curve progression rate. One study showed that the progression rate decreased from 1.47°/year to 0.24° for degenerative scoliosis (p < 0.0001) and from 0.70°/year to 0.24° for idiopathic scoliosis (p = 0.03). Another study showed that there was no statistically significant difference in the Cobb angle or anticipated worsening when comparing the initial measurement with the final control after treatment (p = 0.973). Finally, a third study reported reduced back pain, with Roland–Morris scores improving from 3.3 to 2.0 (p < 0.001) at 18 months. Physiotherapy and multidisciplinary rehabilitation programmes appeared to be effective in significantly reducing pain and disability levels. One study found that Oswestry Disability Index (ODI) scores improved from 39.5 to 31.8 (p < 0.001), while back pain, measured using the Numeric Pain Rating Scale (NPRS), improved from 58.4 to 42.1 (p < 0.001), with 51% achieving minimal clinically important change (MCIC). Another study reported ODI reductions from 38 to 17.6 and pain scores from 6.5 to 2.2 (p < 0.001), while in a third study, the “Koshimagari Exercise” programme yielded MCIDs in the ODI for 42% of patients. Finally, ESIs provided significant pain relief for at least a month in over half of the patients with degenerative scoliosis and radiculopathy, with diminishing effects throughout the first 2 years. More specifically, 37.2% of patients had a successful outcome at one year post-injection and 27.3% at 2 years (p < 0.01). Conclusions: Our study suggests that bracing, physiotherapy, and multidisciplinary rehabilitation programmes, as well as ESIs, can serve as effective short term alternatives for patients with ASD who are either unsuitable for surgery or do not wish to pursue it. As such, this review provides valuable evidence-based insights that can guide clinicians in developing a treatment plan and lay the foundations for establishing a novel pathway for this specific subgroup of patients with ASD.

Study Design Systematic review and meta-analysis. Objective To evaluate inter- and intra-observer reliability of the Lenke classification for adolescent idiopathic scoliosis (AIS) and identify methodological factors influencing agreement. Summary of Background Data The Lenke system is widely used in AIS surgical planning. While initial reports showed excellent reproducibility, subsequent studies have yielded inconsistent results, particularly for lumbar and sagittal modifiers. Methods Following PRISMA guidelines, five databases (PubMed, Embase, Cochrane CENTRAL, Scopus, and Web of Science) were searched to August 2025. Data on observer characteristics, imaging protocols, measurement methods, and statistical indices (κ, ICC) were extracted. Study quality was assessed with QAREL. Descriptive synthesis and random-effects meta-analysis were performed. Results Eleven studies (528 radiographs) met inclusion. Inter-observer reliability averaged κ=0.76 (range 0.50–0.96); lumbar κ=0.75 (0.53–0.92); sagittal κ=0.79 (0.41–1.0). Pooled analysis of two studies with confidence intervals yielded κ=0.69 (95% CI 0.56–0.82; I²=21%). Intra-observer reliability was higher (κ≈0.82). Reliability improved with pre-measured radiographs, experienced observers, computer assistance, and short repeat intervals; it was lower with non-premeasured films, mixed cohorts, and longer intervals. Lumbar modifiers were relatively robust, whereas sagittal reproducibility was most vulnerable to methodological bias. One study illustrated the κ paradox, with high agreement but κ=0.41 due to skewed distribution. Conclusions The Lenke classification is reliable under controlled conditions but less consistent in everyday practice. Reported κ values should be interpreted within their methodological context. Standardised protocols, transparent reporting, and digital tools may improve reproducibility.